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2013-07-30 09:33:39

heparins- pharm
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  1. what family do heparins belong to?
    endogenoussubstances known as glycosaminoglycans (GAGs)
  2. Low molecular wt heparins:
    • Reviparin
    • Enoxaparin
    • Dalteparin
    • Tinzaparin
    • Nadroparin
    • Certoparin
    • Parnaparin
  3. Pentasaccharides:
  4. Heparinoids:
  5. MOA of heparins:
    • Produce anticoagulation by amplifying Antithrombin III which inhibits factors IIa and Xa
    • Increases antithrombin III
  6. kinetics of heparins:
    • Very complex pharmacokinetics      
    •    There is a large range in molecular weight of the molecules
    •    Binds to a lot of proteins (like albumin)
    • The dose-response curve is difficult to predict·        
    •    Dose must be individualized in every patient
    •    Titrated according to the activated partial thromboplastin time [aPTT]
  7. what is the general therapeutic aPTT range? on exam know this!
    45-75 seconds (1.5-2.5x control)
  8. if aPTT is < 35:
    • Increase infusion rate by 4 International Units/kg/hour and rebolus with 80 International Units/kg IV
  9. If aPTT is > 90:
    • Hold infusion for 1 hour and decrease rate 3 International Units/kg/hour.
  10. indications for heparin:
    • Treatment and prevention of inappropriate thrombosis·        
    •   Venous thrombosis (PE) caused by: Stasis, Endothelial damage, Hypercoagulable states
    •   Arterial thrombosis
    •    initial mgment of: MI, unstable angina, coronary angioplasty or stent placement, cardiac surgery
    •    Disseminated intravascular coagulation (DIC)

  11. UFH: which administration has immediate onset of action?
    that you would use when treating DVT...
    • IV
    • effects last a few hrs
  12. UFH: which administration has onset that occurs in 60 minutes?
    use when trying to prevent DVT...
  13. what do you use to measure activity?
    to monitor low molecular wt heparins
    • Anti-Factor Xa levels
    •     aPTT is NOT USED to measure!!
  14. compared to UFR, LMWH has:
    • longer half-life than heparin
    • more predictable kinetic profile
  15. indication for UFH:
    thromboembolism (prophylaxis)
  16. dose for UFH:
    5000 units SC bid q 12 hrs
  17. what is the bridge therapy?
    • bridge warfarin with heparin bc it takes 4-5 days for warfarin to have effects
    • heparin can be d/c on day 5-6 (pts c/ massive PE or severe thrombosis should be off
    • ered a longer period of heparin- ab 10 days)
  18. main SE c/ heparin:
    • Heparin-induced Thrombocytopenia syndrome (HITS)    
    • HAT- heparin assoc thrombo
    • Antibodies against platelet factor 4 are produced and bind to platelets

  19. What is the typical prophylatic for (Lovanox) eroxaparin?  
    • 40 mg SC once daily
    • on exam
  20. VTE treatment with Enoxaparin?
    • 1 mg/kg SC every 12 hours.
    • With a 70 kg person:70 mg SC q 12 hrs
  21. what can be used in the management of patients with heparin-induced thrombocytopenia (HIT)?
  22. CI for heparins?
    • previous HITS
    • coagulopathies
    • active bleeding
  23. SE for heparins:
    • osteoporosis
    • hemorrhage
    • hyperkalemia
    • fever
  24. how can you reverse the hemorrhage?
    with Protamine sulfate
  25. does LMWH have an antidote?
  26. which is safe to use in pregnancy-
    heparin or warfarin??
    • Heparin!!
    • warfarin is teratogenic!!!!
  27. compared to UFH, LMWH--
    1. do not _________ aPTT
    2. more ________ kinetic profile
    3. how are they more convenient?
    • 1. prolong
    • 2. predictable
    • 3. more stable administration and less rigorous monitoring